Provider Demographics
NPI:1134672363
Name:NIPKO, KATRINA (LCSW)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:NIPKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N HARTWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5027
Mailing Address - Country:US
Mailing Address - Phone:608-354-7624
Mailing Address - Fax:
Practice Address - Street 1:3195 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2189
Practice Address - Country:US
Practice Address - Phone:262-646-9960
Practice Address - Fax:262-646-9961
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8379-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134672363Medicaid